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1. You are evaluating a 22-year-old male patient who has recently devel- oped a red He just returned from a 4-day skiing trip, where he and his friends used the hot tub at the ski lodge daily. On examination, you note red dome-shaped pustules involving the hair follicles. What is the likely cause of his rash?
- Streptococcal infection of the hair follicles
- Staphylococcal infection of the hair follicles
- Pseudomonal infection of the hair follicles
- Tinea infection of the hair follicles
- Candidal infection of the hair follicles
2. You are seeing a 7-month-old boy whose mother is concerned about lesions under his nose and on his upper He has had a runny nose for the last 7 days, but his mother thought that was just a cold. Over the last 2 days, he has developed well-demarcated areas of erythema that seem to have ruptured. The crusts over the lesions are golden yellow. What is the likely cause of this child’s lesions?
- Rhinoviral superficial skin infection
- Streptococcal superficial skin infection
- Pseudomonal superficial skin infection
- Haemophilus superficial skin infection
- Pneumococcal superficial skin infection
3. You are seeing a 15-year-old Caucasian male for acne Examination of his face reveals multiple closed and open comedones with- out surrounding erythema or pustules. There is no evidence of scarring. Of the following, what treatment is likely to be most effective for him?
- Topical antibiotic therapy
- Oral antibiotic therapy
- Topical retinoids
- Prescription strength benzoyl peroxide
- Oral isotretinoin (Accutane)
4. You are seeing a 14-year-old high school wrestler for a skin About a week ago, he noted a patch of erythematous skin on his right thigh. The patch has enlarged since he first noted it, and the central part of the lesion seems to be crusting and flaking. He reports that it is mildly pruritic. You scrape the lesion and evaluate the shavings under the microscope using potassium hydroxide. You visualize the following:
What is the most likely diagnosis?
- Tinea corpris
- Tinea cruris
- Pityriasis rosea
- Numular eczema
5. You are evaluating a 40-year-old male patient in the office who is complaining of chest His father had a myocardial infarction at age 42, and the patient is quite concerned. Which characteristic, if included in the history, decreases the likelihood that his chest pain is cardiac in origin?
- The pain is worse with inspiration
- The pain radiates to his right arm
- The pain radiates to his left arm
- The pain is associated with nausea
- The pain is associated with sweatiness
6. You are evaluating a 26-year-old female smoker who developed chest pain several hours Her past history is unremarkable, and she takes no medications regularly. She reports the abrupt onset of nonexertional chest pain, associated with shortness of breath and cough. It seems to be worse when she is lying down. It was not brought on by trauma. Which of the fol- lowing is the most likely origin of her pain?
- Pulmonary embolus (PE)
- Myocardial ischemia
7. You are evaluating a 61-year-old man in the office who is complain- ing of chest Given his history and risk factors, you are concerned about myocardial ischemia. Which of the following features, if present, would most reliably establish cardiac ischemia as a cause?
- Relief of pain with nitroglycerine administration
- Relief of pain with a “gastrointestinal (GI) cocktail” (viscous lidocaine and an antacid)
- Relief of pain with cessation of activity
- Relief of pain with eating
- Relief of pain with sitting up and leaning forward
8. You are evaluating a 20-year-old man presenting to your office with the abrupt onset of chest He has an unremarkable past medical his- tory, but his father had his first myocardial infarction in his late 30s. On examination, he is thin and anxious-appearing. Other than tachycardia, his cardiac examination is normal. His lung examination reveals decreased breath sounds on the right, with hyperresonance to percussion. What is the best treatment for his condition?
- Insertion of a chest tube
- Antibiotic therapy
- Bronchodilator therapy
- Long-term anticoagulation
- 325 mg of aspirin immediately, and transfer to an emergency room
9. A nurse asks you to emergently see a patient who came to the office in distress without an He is 22 years old and is presenting with chest pain. He has never experienced this in the past, and is clearly agi- tated and upset. He reports a history of slightly elevated blood pressure, “heartburn,” and says he is recovering from a recent viral upper respiratory infection. He admits to smoking one pack of cigarettes a day, and has used ille- gal drugs in the past. His blood pressure is 138/90, and physical examination is significant for tachycardia and diaphoresis. Which of his historical features are most suggestive of myocardial ischemia as a cause of his symptoms?
- History of hypertension
- History of “heartburn”
- Recent viral upper respiratory infection
- Smoking history
- Drug use
10. A 45-year-old man with no significant past medical history presents to your office complaining of midsternal chest pain for 5 The pain is described as “sharp.” On examination, the patient has normal breath sounds, but the pain increases with palpation. Which of the following is the most appropriate next step?
- Obtain a chest x-ray
- Obtain a CBC and blood cultures
- Obtain an electrocardiogram (ECG)
- Treat with NSAIDs
- Treat with a proton pump inhibitor
11. A 43-year-old woman with a history of well-controlled hypertension and diabetes presents to your office complaining of intermittent chest pain for the last 3 The last episode was 1 week ago, after climbing four flights of stairs at work. The pain was relieved with rest. An ECG in your office is shown below:
She is currently asymptomatic. Which of the following is the most appro- priate next step?
- Reassure the patient and have her return if symptoms continue
- Reassure the patient, but increase her medication to ensure tight control of her blood pressure and glucose levels
- Admit to the hospital for serial enzymes
- Obtain a treadmill stress ECG
- Obtain a treadmill stress echocardiogram
12. You are evaluating a 75-year-old woman with diabetes and hyper- lipidemia complaining of chest She reports having occasional chest pain with exertion for years, but yesterday she reported syncope with the pain. On examination, she is afebrile with mildly elevated blood pressure. Cardiac auscultation demonstrates a harsh, rasping crescendo-decrescendo systolic murmur heard best at the second intercostal space at the right upper sternal border. Her carotid pulse is small and rises slowly. Which of the following is the most likely diagnosis?
- Aortic dissection
- Left ventricular hypertrophy
- Aortic stenosis
- Mitral valve prolapse
13. You are evaluating a generally healthy 45-year-old man who is com- plaining of chest pain. His symptoms are typical for angina, and are relieved with rest. He is a nonsmoker, has no family history of heart disease, but has high His physical examination and ECG are normal. What is the most appropriate next step?
- Exercise ECG testing
- Exercise echocardiography
- Pharmacologic myocardial perfusion imaging
- Cardiac catheterization
- Electron beam computed tomography
14. One of your patients is undergoing stress testing for episodic chest He is hypertensive and takes hydrochlorothiazide and metoprolol. Which of the following is the most appropriate advice to give this patient prior to undergoing the stress test?
- Continue all medications as directed
- Do not take either antihypertensive medication on the day of the test
- Continue the metoprolol, but do not take hydrochlorozide at least 2 days before the test
- Continue hydrocholothiazide, but withdraw the metoprolol at least 2 days before the test
- Continue hydrochlorothiazide, but withdraw the metoprolol at least 6 days before the test
15. You are seeing a 44-year-old nonsmoker for an acute The cough has been present for 4 days. He had a low-grade fever for the first 2 days, but that has resolved. He reports that the cough is worse at night, has become productive of yellow sputum, but there is no hemoptysis or shortness of breath. What is the most likely cause of the cough?
- Sinusitis with postnasal drip
- Viral upper respiratory infection
16. A 33-year-old nonsmoking man presents to you for evaluation of his chronic He says the cough has been present for about 8 weeks. Ini- tially, he went to an urgent care where he received antitussives and a bron- chodilator. Those did not help, and he returned 1 week later and was given a course of azithromycin. His cough has continued to persist. His symp- toms are worse when he lies down for sleep, and are associated with a sore throat and a “sour” taste in the back of his mouth. He has also noticed that when he drinks caffeine or alcohol, the cough seems to worsen. What is the most likely diagnosis?
- Gastroesophageal reflux
- Side effect from a medicaiton
- Chronic bronchitis
17. You are treating a 52-year-old woman with a 40-pack/year history of She reports a productive cough that has been present for the last 3–4 months, beginning in the fall. She remembers having the same symp- toms last year in the fall, and attributed it to a “cold that she just couldn’t kick.” She does not have fevers, reports mild dyspnea when walking up stairs, and denies hempotysis. What is the most likely diagnosis?
- Irritation of airways from cigarette smoke
- Chronic bronchitis
- Postnasal drainage due to seasonal allergies
- Lung cancer
18. Four weeks ago, you treated a 22-year-old woman for acute bronchi- Although she feels much better, the cough has persisted. She has used bronchodilators, antihistamines, and antitussives. What is the best course of treatment at this time?
- A 10-day course of amoxicillin
- A 5-day course of azithromycin
- Steroid nasal spray
- An oral steroid taper
19. You are seeing an 18-year-old man who has had a cough for 2 It started like a typical “cold,” but has persisted. Over the last 3 days, the cough has come in “spasms” and he barely has time to catch his breath dur- ing the coughing episodes. Nasopharyngeal swab confirms the diagnosis of pertussis. Which of the following treatments is recommended?
- A 10-day course of amoxicillin
- A 10-day course of amoxicillin/clavulanate
- A 10-day course of erythromycin
- A 5-day course of azithromycin
- Supportive therapy without antibiotics, but in isolation
20. You are seeing a 6-month-old boy whose mother reports that he has had diarrhea for almost 2 He has had 4–6 bowel movements a day, with a loose to liquid consistency. His mother stays at home with him and the child is not in daycare. His symptoms began after his young cousins visited for Christmas. What would be the most likely cause of his diarrhea?
- Norwalk virus
- Enterotoxigenic E. coli